Overview of results from selected systematic reviews of non-pharmacological; complementary and alternative medicine and therapy trials

Treatment(review reference)

No. of trials(no. of participants*)Review quality

Dosages; durations of treatment

Overall trial quality†

Safety and comments

Acupuncture70

9 (395)AMSTAR=11

Treatment sessions ranged from 3 to 13 weeks (median=4), with needle retention ranging from 20 to 30 min. Only one study provided journal references for the acupuncture point selection, and the description of the type of needle stimulation/manipulation was clear in only three studies.

Moderate

One in six people who had acupuncture, and one in three controls, reported adverse events. Such events were minor and lasted less than one day. No serious adverse events were reported in any trials.

Biofeedback92

7 (321)AMSTAR=8

EMG biofeedback.Individual sessions varied between 45 and 180 min, and the number of sessions varied between 6 and 16.EEG biofeedback.20–22 sessions of (where reported) 30 min duration.

Median duration of therapy=10 weeks, with a median number of 10 sessions, and median total hours=18 hours. All but two studies delivered therapy face to face. Median follow-up (where this was performed 17/23 studies)=6 months.

Low

The assessment of safety in most studies was insufficient.Two studies reported dropout due to worsening of comorbid mental disorders. However, CBT is generally considered safe.

Exercise41

34 (2276)AMSTAR=9

Exercise programmes lasting 2.5–24 weeks. Aerobic exercise for ≥20 min, once a day (or twice for ≥10 min), 2–3 days a week. Strength training with ≥8 repetitions per exercise, 2–3 times a week.

Moderate

Although patients may initially notice a deterioration in symptoms, exercise is generally considered safe, especially when practised under supervision.

Hydrotherapy/spa therapy76

10 (446)AMSTAR=9

Wide variation in precise treatment strategy between trials. Most consisted of water or mud baths at body temperature 36–37°C, or slightly above (40–45°C), with a median treatment time of 240 min (range 200–300), over several weeks.

Low

Three studies reported no side effects of treatment; one reported slight flashes in 10% of the patients. The remaining trials did not explicitly mention safety.

Hypnotherapy91

4 (152)AMSTAR=11

Some variation between trials ranging (where reported) from 300 to 420 min, delivered over 10–26 weeks.

Good

Adverse events were not reported in any of the trials.

Massage63

9 (404)AMSTAR=7

Massage therapy time lasted 25–90 min, with between 1 and 20 massage sessions in total.

Although no serious adverse events were reported, six participants (3.1%) withdrew from the trials because of adverse events (increase of pain; muscle inflammation; chlorine hypersensitivity). The review authors concluded that the acceptance and safety of all types of meditative movement therapies were high.

Mindfulness/mind–body therapy84

6 (674)AMSTAR=9

Some variation between trials. Single 2–3.5 hours session per week, for 8–10 weeks. Four out of six programmes also included daily home practice (30–45 min) plus a single all-day retreat.

Low

Safety was assessed and reported in none of the trials.

Multicomponent therapy60

9 (1119)AMSTAR=9

Enormous variation in treatment strategies between trials. Most included different combinations of exercise (land and/or water based); education; relaxation; and/or some other specific therapeutic component (eg, Tai Chi; or massage).

Moderate

No adverse events were reported in any of the trials.

SAMe93

1 (44)AMSTAR=6

400 mg tablet, twice a day, for 6 weeks.

Moderate

Mild adverse effects such as stomach upset and dizziness were reported.

‡Elsewhere in the review, it reports that three studies reported on adverse events. However, in the table where these data are presented, it is only clear for two. However, in a third trial, there were no dropouts due to side effects.

§These data were not contained in this review. The initial recommendation for chiropractic was weak against. However, after discussion, this was downgraded to strong against due to potential safety concerns.